Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | AC10529 | CA |
NPI | 1174776603 |
---|---|
Provider Name | Chao Pang |
First Address | San Gabriel, CA 91776-3549 |
Second Address | Rosemead, CA 91770-3647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 28/10/2008 |